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COMMONWEALTH OF VIRGINIA

DEPARTMENT OF TRANSPORTATION

RULES GOVERNING PREQUALIFICATION PRIVILEGES

Purpose

Section 2.2-4317 of the Code of Virginia ensures that all contracts for the construction, improvement, and maintenanceof roads are awarded to the lowest responsible bidder. Contract award is to be the result of open competition in

bidding; impartiality in the selection of contractors; integrity in business practices; and skillful performance of publiccontracts. The Commonwealth Transportation Board, as the governing body of the public agency, has wide discretionin determining the responsibility of the contractor particularly regarding their moral and ethical judgment.

Certain rules for establishing proof of the competency and responsibility of those who wish to submit bids wereapproved by the Board on August 18, 1960. Accordingly, each Prospective Bidder on contracts advertised by the

Virginia Department of Transportation shall submit an Application on the forms provided to become prequalified.These forms require the completion of information on the ownership of the firm, experience of its personnel, equipmentunder their control, any affiliations with other construction firms and the type of contracts for which qualification isrequested. In conjunction with this Application, the contractor shall furnish a complete original Annual FinancialStatement (current within the previous 12-month period).

The following will set forth the rules and regulations adopted by the Commonwealth Transportation Board.



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Form C 468-1-05

I DEFINITIONS

A. Affiliate – Any business entity which is closely associated to another business entity so that one hasthe power to control the other either directly or indirectly; or, where one business entitysystematically shares resources, officers, and/or other management with another business entity tothe extent that a business relationship legally exists or is publicly perceived to exist; or, when athird party has the power to control both; or, where one business entity has been so closely alliedwith another through an established course of dealings, including but not limited to the lending offinancial wherewithal or engaging in joint ventures, so as to cause a public perception that the twofirms are one entity.

B. Board of Review – Will be an assembled panel to review appeals of decisions made by thePrequalification Committee. This Board will be assembled in accordance with Section 2.2-4365 ofthe Code of Virginia.

C. Commissioner – The Commonwealth Transportation Commissioner or his designee.

D. Contractor or Firm – Any person, partnership, corporation, limited liability company, business trustor other business entity that is eligible through prequalification to bid on contracts let by the

Department, or that functions or seeks to function, as a subcontractor on any such contract used inthe construction or maintenance of a part of the Commonwealth’s highway system. This firm must be legally authorized, as stated in Section 13.1 of the Code of Virginia, to conduct business in theCommonwealth.

E. Department – The Virginia Department of Transportation.

F. Disadvantaged Business Enterprise or DBE – means a “for profit” small business concern –

1. That is at least 51 percent owned by one or more socially and economicallydisadvantaged individuals or, in the case of a corporation, at least 51 percent of the stock

of which is owned by one or more such individuals; and

2. Whose management and daily business operations are controlled by one or more of thesocially and economically disadvantaged individuals who own it.

G. Engineer – The Chief Engineer or his authorized representative. The representative acts within theauthority given to him.

H. Experience Modification Ratio (EMR) – A standard factor used in the pricing of Worker’sCompensation Insurance, which is based on the employer’s claim history.

I. Letting – The process of publicly opening the sealed bids.

J. Non-Current Assets – Those assets that a firm possesses that are not liquid for the current fiscal

year.

K. Non-Current Liabilities – Those liabilities that a firm possesses that are not payable for the currentfiscal year.

L. Prequalification – Qualification of a firm is based on its bonding ability, equipment availability,

experience of key personnel, safety record, and past performance of the firm in highwayconstruction.

M. Prequalification Committee – A panel consisting of the Contract Engineer, ConstructionManagement Engineer, and the Administrative Services Division Administrator or their designee.



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N. Prequalification Score – Score used in determining a firm’s eligibility for prequalification by theDepartment. This score is derived using the following formula:

Prequalification Score = (Quality Score X .70) + (Safety Score X .30)

O. Prospective Bidder – Any person, firm or business entity that intends to submit bids on contracts

advertised by the Department.

P. Quality Score – A number that is derived from a firm’s Quality of Performance Evaluation basedon past performance on Department contracts. This score is 70% of a firm’s Prequalification Score.(See Appendix B)

Q. Safety Score – A number that is based on a Firm’s Experience Modification Ratio (EMR). Thisscore is 30% of a Firm’s Prequalification Score. (See Appendix C)

II GENERAL REQUIREMENTS

A. All firms must be prequalified prior to submitting a bid as a prime contractor or beginning work asa subcontractor.

B. All bidders must comply with the bonding requirements in Section 103.05 of the current Road andBridge Specifications.

C. There is no limit on the amount of work a prequalified firm can have underway as a subcontractor.



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Form C 468-1-05

III APPLICATION

The same application will be required whether a firm wishes to bid as a prime contractor or to work as asubcontractor.

Firms desiring to bid on highway projects with a cumulative value in excess of $100,000 are required to file acomplete original annual financial statement (must be current within the past 12 months) and an originalCertification of Experience Modification Rate letter (see Appendix A).

Firms unable to obtain a bond for the total value of the work they intend to bid on will be limited to biddingon highway projects with a cumulative value of $100,000. These firms are required to file a complete originalannual financial statement or annual balance sheet (must be current within the past 12 months) and anoriginal Certification of Experience Modification Rate letter (see Appendix A).

A. Organizational Structure – The firm shall provide a list of all owners, officers, partners, orindividuals authorized to represent or conduct business for or sign legal documents for thefirm. This list must include the full legal name, typed or printed in a clear legible form, asignature, and State Driver’s License Number for any principal of the firm that is authorized tosubmit a bid on the behalf of the firm.

Firms experiencing changes in ownership, organizational structure, or changes in assets mustinform the Department within 30 days. Failure of the contractor to comply with thisrequirement may result in suspension of the contractor’s prequalification until the requiredsubmission is made and review completed.

B. Classification – The firm shall indicate the type(s) of work the firm’s workforce andequipment normally perform. Qualification for one or more types of work will be based onthe adequacy of equipment, experience, bonding ability, and other pertinent information.

C. Experience – The firm shall furnish information that documents the ability of theirorganization to undertake a project involving the type(s) of work for which prequalification isrequested.

D. Equipment – Firms must document the ability to access sufficient equipment to perform thework, or have sufficient assets to purchase/lease the necessary equipment. Ownership or

control of specific equipment may be required. The firm shall furnish a list of all equipmentavailable, whether owned, leased, or otherwise acquired. Arrangements such as valid leases,rental agreements, status as owner, major stockholder, or officer in an equipment company,may be considered. Such arrangements must be reported and fully explained.

E. Legal Authorization – All firms shall be legally authorized to conduct business in theCommonwealth as stated in Section 13.1 of the Code of Virginia.

F. Work underway Reports (Forms C-42 and C-42a) –Both forms, C-42 and C-42a arerequired to be submitted annually with the prequalification application, or upon a request bythe Department.

G. Submitting – The application is to be submitted to the Department at least thirty (30) calendardays prior to submitting a bid or applying to work as a subcontractor. The act of submittingthe application does not permit the firm to submit a bid or begin work as a subcontractor. It isthe responsibility of the firm to be prequalified before bids are opened, before signingsubcontractor agreements, and before requesting to be approved as a subcontractor.Incomplete applications will be returned for further detail or correction.

The application is to be signed, notarized, and mailed/delivered to:

Virginia Department of TransportationScheduling and Contract Division, Prequalification Section

1401 East Broad StreetRichmond, Virginia 23219



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H. Review of Application – The Department’s Prequalification Officer will review allinformation to determine the firm’s prequalification eligibility and the type(s) of work theworkforces and equipment normally perform. Upon completion of the Department’sPrequalification Officer’s review of the firm’s application, the firm may be granted one of thefollowing three levels of prequalification:

1. Prequalified – in good standing with the Department and may bid on all projects upto their bonding ability. This level of prequalification requires a minimumPrequalification Score of 80, a minimum Quality Score of 85 and a minimum SafetyScore of 70.

2. Prequalified (Probationary) – a firm with this level of prequalification is in goodstanding with the Department with regard to safety and has a demonstrated ability tocomplete the type of work for which they are requesting prequalification but has not

performed work for the Department and thus has no Quality Score. With this levelof prequalification a firm can be awarded/have under contract no more than three

projects at any given time. Each of these contracts will be limited to a maximumcontract value of $2,000,000. The Contract Engineer has the authority to waive thisrestriction on a project-by-project basis. Such waiver must be obtained, in writing,

by the firm prior to bidding on that project. A firm with this level of prequalificationmust file an updated Form C-42 including all active VDOT projects each time they

submit a bid. A firm at this level of prequalification will be assigned a minimumPrequalification Score of 75, provided they have a minimum Safety Score of 70.

3. Prequalified (Conditional) – a firm with this level of prequalification is below theDepartment’s desired standard in the area of quality and/or safety. This level of

prequalification may also be considered for situations where a firm or its officershave previously filed for bankruptcy. With this level of prequalification a firm can

be awarded/have under contract no more than one project at any given time. Thiscontract will be limited to a maximum contract value of $1,000,000. The ContractEngineer has the authority to waive this restriction on a project-by-project basis.Such waiver must be obtained, in writing, by the firm prior to bidding on that

project. A firm with this level of prequalification must file an updated Form C-42including all active VDOT projects each time they submit a bid. This level of

prequalification requires a minimum Prequalification Score of 70, a minimumQuality Score of 75 and a minimum Safety Score of 60. Should the firm not improve

to meet the Department’s standards by their next prequalification renewal, theContract Engineer may Administratively Revoke the firm’s prequalification

privileges until the Department’s standards are met.

I. Certificate of Qualification – The firm becomes prequalified when approved by thePrequalification Officer. A Certificate of Qualification signed by the Department’s ContractEngineer will be issued following the firm’s prequalification approval.

The firm should allow 30 calendar days for the prequalification administrative process to becompleted.

If the firm is denied prequalification, they may submit supplemental information that correctsany deficiencies. If this information is not received within sixty (60) calendar days, a newapplication (Form C-32) will be required to be submitted.

IV APPEALS PROCEDURE

The firm has two methods of appeal for an unsatisfactory or denied Certification of Qualification. These twomethods include:

1. Letter of Quality Assurance – A letter of quality assurance can be filed explaining the methods by which the reasons for denial will be corrected. If the Contract Engineer accepts this letter,the Department will issue a Certificate of Qualification.



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2. The Hearing Process – If a letter of quality assurance does not produce a satisfactory result oris not submitted, a hearing before the Prequalification Committee may be requested. Thiswritten request must be filed within ten (10) working days after the Certificate of Qualificationis issued or after the notification of denial. The hearing shall be scheduled for a mutuallyagreeable time. Within ten (10) working days after the hearing, the PrequalificationCommittee will write the contractor describing the Committee’s findings and the status of theCertificate of Qualification.

If the firm is dissatisfied with the Committee’s findings, they may request a hearing before the Board ofReview. This written request must be filed within ten (10) business days of the Committee’s ruling. Thehearing shall be held at a mutually agreeable time, whereupon:

The firm may submit additional information.

The Board will review all information.

A ruling shall be determined by means of a simple majority.

The ruling of the Board of Review is final.

This ruling shall be forwarded to the Prequalification Committee. Within ten (10) working days of theBoard’s ruling, the Committee shall supply written notification of the final decision to the firm.

V EXPIRATION

The firm’s prequalification privileges will expire at the assigned expiration date on the certificate ofqualification.

Renewal of Prequalification and the Two-year Prequalification Cycle

Prequalified contractors are required to submit a full application (Form C 32), a new certification ofexperience modification rate, forms C-42 and C-42a and a complete original annual financial statement everytwo (2) years, or on other intermediate occasions as may be considered necessary by the contractor or theDepartment. In the event the Department determines that conditions warrant re-evaluation of a contractor’squalifications, the Department may require the contractor to submit an additional full application (Form C

32), new forms C-42, C-42a, and a complete original annual financial statement or an annual balance sheet. This annual financial statement or annual balance sheet must be current (within the past 12 months).

Prequalified firms nearing the first year of their prequalification cycle need only to submit the prequalification/certification renewal application (Form 32A), new forms C-42 and C-42a, new certificationof experience modification rate, and a complete original annual financial statement. Applications shall befiled within thirty (30) calendar days prior to the expiration date of the current prequalification.

VI. WORK UNDER CONTRACT

A. PRIME CONTRACT WORK

All bidders are required to submit Form C 42 to the Prequalification Officer annually or upon a request by the Department. All projects in progress, or awarded but not yet begun, for where the firm is the low

bidder pending the formal award of the contract, as a prime contractor must be listed. Form C 42 shall be signed by a person authorized to transact business on behalf of the firm as listed on Part B of thePrequalification Application, certifying that to the best of their knowledge the data furnished is completeand accurate. Each project on the form shall include the following data:

Owner

Location and Description

Contract Amount

Balance to be Completed



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B. SUBCONTRACT WORK

All firms are required to submit an annual status of current subcontracts on hand (form C-42A). Form C-42A is required to be submitted annually, or upon a request by the Department. All projects where the firmhas work in progress as a subcontractor, and all signed subcontract agreements where the work has not yet

begun, must also be listed. Each project on the form shall include the following data:

Owner

Prime Contractor

Location and Description

Contract Amount

Balance to be Completed

VIII SUBCONTRACTOR

All subcontractors must be prequalified with the Department unless the item to be sublet is denoted in thecontract as a specialty item or the item is indicated as a waiver of prequalification, or the item is declared aspecialty item by the Contract Engineer

IX PERFORMANCE EVALUATION

The District Administrator is required to complete a Quality of Performance Evaluation on each contractorand sub-contractor completing a contract in their district. This evaluation will be completed at the end ofeach project and/or at the end of each construction season for projects that are scheduled for more than one(1) year. This report will be used as a basis for determining the contractor’s Performance Rating, andultimately helping determine the firm’s prequalification status.

X TERMINATION OF PREQUALIFICATION PRIVILEGES

A. Prequalification privileges end at the assigned expiration date on the Certificate of Qualificationunless extended by the Department.

B. Prequalification Extension Policy – All firms with a Prequalification Score of 80.0 or above areeligible to obtain a prequalification extension. Prequalification extensions are limited to three 30-day periods. All requests for an extension of a firm’s prequalification are required to meet thefollowing standards:

1. The letter requesting each 30-day extension is required to meet the following standards:

a. Be on the firm’s original letterhead stationary.

b. Be dated before the firm’s current prequalification expires.

c. Be signed by a person authorized to transact business on behalf of the firm aslisted on Part B of the Prequalification Application. (Form C32).

All prequalification extension requests are required to be received in the Prequalification Office ina window opening 30 days before the firm’s prequalification date, and closing on the firm’s

prequalification expiration date.

C. Prequalification privileges can be administratively revoked immediately if the firm is found to be inviolation of the prequalification rules and regulations. Examples include, but are not limited to, thefollowing:



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1. The firm is found not to be in good legal standing with the Virginia State CorporationCommission (SCC).

2. Monies owed the Department.

Prequalification privileges, which are administratively revoked, will be reinstated when the firm isfound to be back in compliance with the prequalification rules and regulations.

D. Prequalification privileges can be suspended if the firm is documented to be in violation of Sections102.01, 102.08 or 110 of the current Road and Bridge Specifications or if the firm has been debarred bya state or federal agency. Firms whose prequalification privileges have been suspended will be enjoinedfrom bidding during the term of the suspension. Examples include, but are not limited to, the following:

1. Documentation of the lack of progress on the Department’s projects as stated in Section102.01 of the Road and Bridge Specifications.

2. Documentation of poor workmanship on the Department’s projects as stated in Section 102.08of the Road and Bridge Specifications.

3. Documentation of the failure to meet DBE requirements on the Department’s projects asstated in Section 110 of the Road and Bridge Specifications.

4. Debarment by some other state or federal agency for any reason.

E. Prequalification privileges can be lost if the firm is found in violation of any of the reasonscontained in the Department’s “Debarment policy.”



If Prequalification is

Probationary, Conditional or Denied

Even if the firm is denied Prequalification, all may not be lost. The following are someactions the firm can take to appeal the evaluation.

Short term actions

Submit supplemental material within the 60 day evaluation period

All firms are given a sixty (60) calendar days to correct all the deficiencies on their

Prequalification Applications (Form C-32). Supplemental information can be used to

revise a firm’s Prequalification, if it is received within this 60 day evaluation period.After the (60) day evaluation period has passed, the evaluation period is over and

supplemental will material not be accepted.

After the Prequalification Evaluation process is complete, if the firm is unsatisfied with

its evaluation, it should promptly notify the Prequalification Office in writing that it

wants to appeal its Prequalification status.

The First Level Of Appeal

Letter of Quality Assurance

A Letter of Quality Assurance can be submitted to the Prequalification Office for review

by the Contract Engineer. In this letter, the contractor needs to document that a poorQuality Score and/or a poor Safety Score is an isolated case in a long history of good

scores. Information from other states, and from the private sector can be submitted to

document the firm’s overall good performance track record.

Quality/Safety Improvements

The firm should be able to document what changes it has made to improve quality/safetyon future projects with the Department. Documentation of new programs designed to

improve work quality and safety should be submitted. Employees hired to implement and

enforce these programs should be documented. Other changes in staff to improve safetyand quality should be noted.

Past Performance Reports

Upon written request the Prequalification Office can furnish a copy of the computer

print out of the scores that were used in the evaluation. If the firm has copies of missingPerformance Reports, they should be furnished to Contract Engineer as part of this

appeals process.



If your firm has not received its Annual Performance Report and/or the Performance

Report upon the completion of a project, contact the District Construction Engineer.

Request that the District Construction Engineer have the Performance Report performed,

and that he/she promptly furnished the original to the Contract Engineer for use in the

appeals process.

After all the information has been received and reviewed, the Contract Engineer has the

authority to revise the Certificate of Qualification or award the firm a Certificate of

Qualification.

If the Letter of Quality Assurance is unsuccessful the firm may choose to continue the

formal appeals process. A copy of the Prequalification Appeals Process is attached.

Long term actions

Improve the Prequalification Score

The Prequalification Score is derived from the Quality Score and the Safety Score.

Therefore in order to improve the Prequalification Score, the firm must improve eitherthe Quality Score or the Safety Score, or both.

The Quality Score is 70% of the Prequalification Score. It is based on performancereports that are submitted by VDOT’S field forces. Improved field reports can help a firm

raise its Quality Score. The firm may want to perform smaller subcontract work in order

to receive improved field reports. These improved field reports can be used to raise thefirms Quality score on future Prequalification evaluations.

The Safety Score is 30% of the Prequalification Score. This independently developed

score is a three year average of the Experience Modification Ratio (EMR) scores. The

EMR is computed by comparing the accident rate of each individual company to theaccident rates to all other companies in the state and in the industry. Since the Safety

Score is a three (3) year average, it may take a year or more for an improvement in a

firm’s accident rate to be reflected in the Safety Score. Improved Safety Scores can be

used on future Prequalification evaluations.



The Prequalification Appeals Process

The Right to Appeal

After the Prequalification Evaluation Process is complete, if the firm is denied

Prequalification or receives an unsatisfactory Certificate of Qualification, it has a right to

a prompt appeal.

Beginning the Appeals Process

The Appeals Process begins when the contractor formally notifies the PrequalificationOffice, in writing, that it wants to appeal the unsatisfactory Certificate of Qualification or

the Denial of Prequalification.

The Prequalification Office will promptly (by fax) furnish the contractor a copy of thisPrequalification Appeals Process procedure.

First Level of Appeal

In the first level of appeal the contractor submits a Letter of Quality Assurance, to the

Prequalification Office stating that the firm is appealing the firms prequalificationevaluation. The letter needs to explain the methods by which the reasons for the denial

will be corrected whereupon:

The Contract Engineer will review the Letter of Quality Assurance and all submitted

Prequalification information.The Contract Engineer will render a decision

The Certificate of Qualification will be revised, or the contractor will be sent a letter

documenting the reasons for the denial of the appeal.

Second Level of Appeal

If the Letter of Quality Assurance does not produce a satisfactory result, the contractormay appeal to the Prequalification Committee for a formal hearing. A written request

must be filed with the Prequalification Office (also copy the Contract Engineer) within

ten (10) working days after the Contract Engineer has issued a decision on the firm’sappeal. The hearing shall be scheduled for a mutually agreeable time, whereupon:

The contractor may submit additional informationThe Prequalification Committee will review all information

The ruling shall be determined by a simple majority



The Prequalification Committee will notify the contractor in writing within ten (10)

working days describing the committee’s finding and the status of the Certificate ofQualification.

Third Level of Appeal

If the contractor is dissatisfied with the Prequalification Committee’s findings, a request

for a hearing may be made to the Board of Review. This request must be filed with the

Prequalification Office (also copy the Scheduling and Contract Administrator) within ten(10) working days of the Prequalification Committee’s ruling. The hearing shall be held

at a mutually agreeable time, whereupon:

The contractor may submit additional information.

The Board of Review will review all information.

The ruling shall be determined by a simple majority.The ruling of the Board of Review is final.

This ruling shall be forwarded to the Prequalification Committee. Within ten (10)

working days of the Board of Review, the Prequalification Committee shall supplywritten notification of the final decision to the contractor.



HIGHWAY CONTRACTORS

PREQUALIFICATION SUBMISSION GUIDE

REQUIRED SUBMISSIONS

First Year

___ An original certification of Experience Modification Ratio (EMR) letter from thefirms Workers Compensation Insurance company.

___ A complete original annual financial statement from a CPA or complete page 9 of

(Form C-32) ___ Current Prime Contracts On Hand (Form C-42).

___ Current Subcontracts On Hand (Form C-42A)

___ Prequalification Application (Form C-32)

Second Year

___ An original certification of Experience Modification Ratio (EMR) letter from the

firms Workers Compensation Insurance company. ___ A complete original annual financial statement from a CPA or complete page 9 of

(Form C-32).

___Current Prime Contracts On Hand (Form C-42) ___ Current Subcontracts On Hand (Form C-42A)

___ Prequalification Renewal Application (Form C-32A)

___ Annual Gross Receipts Survey (page 10 of Form C-32.

OPTIONAL SUBMISSION

(Both Years)

___ Request To Protect Materials Under the Virginia Freedom of Information Act (FormC-47).

ATTENTION

Your firms Prequalification submission is considered a legal document by both the

Virginia and the Federal Court Systems. Therefore ACCURACY IS MOREIMPORTANT THAN SPEED in processing your submittal. Please review your

information before it is submitted to prevent delays caused by making corrections.



Form C327-10-06

VIRGINIA DEPARTMENT OF TRANSPORTATIONPREQUALIFICATION APPLICATION

This application is to be completed by all firms desiring to work or bid on VDOT highway construction contracts.

GENERAL INFORMATION

1. Company’s Full Legal Name____________________________________________________________

Street Address ________________________________________________________________________________City State Zip Code

Mailing Address (if different) ________________________________________________________________________City State Zip Code

____________________________________( )_______________________________________( )____________________Federal Tax ID Number Telephone Number Fax Number

____________________________________________________________________________________________________________Contact Person (Must be a person who is authorized on Page 2) and email address ( email address will be kept confidential)

____________________________________________________________________________________________________________

Firm Email address and contact person to be listed on VDOT website

2. Firms Legal Status and History (please check the type of business entity)

___ Corporation ___ Limited Liability Company ___ Sole Proprietorship

___ Limited Partnership ___ General Partnership ___ Business Trust

Date this firm was established:_______________________________________________________________________

Has this organization transacted business under any other name? _____ YES _____ NO

If yes, under what name(s) did the firm transact business? _________________________________________________

3. What is the value of the largest project the firm intends to bid? __$________________________________________

4. What is the total value of work the firm can perform at any one time? $_____________________________________

Has the firm ever filed for bankruptcy? _____Yes _____ No (If yes, please provide a explanation on a separate sheet)

5. Are all owners U.S. citizens? ______________ If not, please submit a photo copy of each owner's current INS Registration Cards (Form I-151 or I-551). 6. Ownership of Firm - Document all individuals owning 10% or more of the firm.

-1-Full Legal Name

-2-Driver’s License Number and

State

-3-Years of

Ownership

-4-Ownership

Percent

-5-VotingPercent

(Corp. only)

If additional space is needed, any page of this application may be copied and added for your convenience.* For internal Department use only. Information will not be used in the determination of a firm’s prequalification level.

Form C 32



CONFIDENTIAL

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Form C 327-10-06

Individuals Authorized to transact Business with the

Virginia Department of Transportation

Document all owners, officers, partners or individuals within your organization who in any way and/or to any extentare authorized to represent, transact business or sign legal documents and contracts on behalf of the firm with VDOT.In the event any of these individuals holds any office or has any interest in any other firm or firms, please state hisaffiliation or involvement within these firms.

The executed signature on future bid proposals and all other legal documents submitted to VDOT must be identical tothe signatures on this document. Different styles of an individual’s signature may be placed on file. Two or moresignatures are requested, but not required. No other individuals should attempt to represent, transact business or signdocuments and contracts on behalf of the firm with VDOT.

1.

Print full legal name Position Held in this firm Signature

______________________________________________ Are you involved in another firm? _____ YES _____ NO

State Driver’s License Number (attach photo copy)

Name of Other Firm Position Held in Other Firm Financial interest in other firm

2.Print full legal name Position Held in this firm Signature

______________________________________________ Are you involved in another firm? _____ YES _____ NOState Driver’s License Number (attach photo copy)


3. ________________Print full legal name Position Held in this firm Signature











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FIRM TO FIRM RELATIONSHIPS - (All applicants must complete Item A or B)

A. Document all names and complete addresses of all affiliated, financially associated, and subsidiary companies.

Affiliate – Any business entity that is closely associated to another business entity so that one entity controls or has the power to control theone business entity systematically shares resources, officers, and/or other management with another business entity to the extent that a busin

perceived to exist; or, when a third party has the power or controls both; or when one business entity has been so closely al lied with anotherof dealings, including but not limited to the lending or financial wherewithal, engaging in joint ventures, etc. as to cause a public perception

-1- Name of Affiliated

Company

-2-Affiliated Firm’s Address

-3-Federal TaxID Number

-4-Affiliated Firm’s

Type of Work

-5-* Affiliated Firm’s

Relationship toThe Applicant

*Relationship between firms may be simply stated as: Grandparent, Parent, Brother/Sister or Child. If firms are related by common owners2 of this application is involved with another firm, the other firm should be listed and the firm’s relationship to the applicant should be stated

A diagram (Flow Chart) may be submitted as an addition to this list to document the relationship between the firms.

B. is not directly or indir(Name of Firm Seeking Prequalification)



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Immediate Family Member Business Relationships (Please complete this form for each individual owner of the firm listed on page 1 andtransact business with the Virginia Department of Transportation on page 2.)

ALL OWNER S & AUTHORIZED PERSON'S NAME (ONE PERSON PER PAGE): ________ _ _______________________ ___________

Do any of your immediate family members own or are involved with another VDOT prequalified contractor? For purposes of this section, “

mother, father, son, daughter, brother, sister.

_____ YES_____ NO If yes, please address the following for each relative:

-1-

Relative’s Name

-2-

Relationship

-3-

Company Name

Sheet _____ of ______



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Form C 32

7-10-06 Firm’s Focus Area of Highway Construction

Please check the work classes that best describe the work performed by your firm’s work force using your firm’sequipment. Do not include the work performed by subcontractors. Please limit your selections to 10 work classes.

_____Grading (002) _____Excavation (101)

_____Demolition of Building (015) _____Demolition of Structures (080) _____Clearing & Grubbing (011)

_____Tunneling (043) _____Jacking & Boring of Pipe (024) _____Micro Tunneling (176) _____Roadside Development (033)

_____Landscaping (106) _____Erosion Control (070)

_____Wetland Mitigation (063) _____Soil Stabilization (036) _____Underdrains (044) _____Drilling & Blasting (058)

_____Dredging (017) _____Major Structures (003) (spans greater than 30’)

_____Erection & Fabrication Structural Materials (019) _____Cathotic Protection (160)

_____Welding (083) _____Post Tensioning (057)

_____Reinforcing Steel Placement (023) _____Pile Driving & Caisson Foundation (030) _____Shoring/Sheeting (082)

_____Waterproofing (042) _____Bridge Repair (055)

_____Deck & Surface Repair (177) _____Epoxy Work (071) _____Pneumatically Applied Concrete (178)

_____Marine Construct ion (054) _____Underwater Construction & Repair (081) _____Underwater Utilities (051) _____Marine Salvage (075)

_____Subsurface Investigation (076) _____Tunnel Finishing (042)

_____Painting of Bridge & Structures (028) _____Minor Structure (007) (Spans Less than 30’) _____Drainage Structures (005) _____Masonry Construction (056)

_____Guardrail (021) _____Fencing (020) _____Signing (035) _____Portland Cement concrete (006)

_____Pavement (179) _____Incidental Concrete (022) _____Slip Forming (180) _____Pneumatic Mortar (031) _____Pavement Sawing & Grooving (049) _____Joint Repair/Underseal Pavement (050)

_____Asphalt Pavement (004) _____Surface Treatment (171) _____Roadway Milling (013)

_____Slurry Seal of Pavement (068) _____Others

_____Utilities (045) (Water, gas, sanitary sewer, electrical, telephone, and cable)

_____Hazardous Waste Removal (133) _____Railroad Construction & Repair (032) _____Electrical Instal lation (018)

_____Roadway Lighting (072) _____Traffic Signalization (052)

_____Traffic Management Systems _____Variable Message Signing (165)

_____Temporary Traffic Management (078) _____Pavement Markings (029)



6

FIRM’S PRIOR WORK EXPERIENCE –

List projects this firm has completed in the past three years. Work performed beyond three years may be shown if desired. (List all work thcapability in the areas checked on Page 5.) If you answer ‘yes’ to #5 through #7, please explain using the reference numbers at the top of e

-1- Name of Owner

-2-State Project No. or Location

-3-Specific type of work

performed

-4-Contract Price



7

Form C 327-10-06

FIRM’S OWNED EQUIPMENTPlease list the owned and operating highway equipment (ONLY) that this firm owns and uses to perform the requestedwork classes on Page 5.

-1-Description & Capacity of each item.

-2-Serial Number or VIN Vehicle ID Number

-3-Age



8

Form C 327-10-06

LEASED EQUIPMENT – OPTIONAL (For firms using leased equipment to support the requested workclasses on Page 5.

Leased or rented equipment may be considered if it is listed below and a copy of a past leased or rented agreement issubmitted. The equipment dealer must submit a letter documenting the equipment was leased or rented to the firm in the

past and its willingness to lease or rent the equipment to the firm in the future.

-1-Description & Capacity of each item

-2-Serial Number or Vehicle ID

Number

-3-Age

-4-LeaseAttached



9

Form C 327-10-06

ANNUAL BALANCE SHEETFINANCIAL INFORMATION (For use by Firms not submitting an annual financial statement prepared by aCPA. Please DO NOT submit an annual income statement or tax returns.)

Firm’s Name_____________________________________________________________________________________

For the Fiscal year (12 months) ending _______________________________________________________(Show Month/Day/Year)

ASSETS

Current Assets (1 year or less):Cash & Bank Account _________________Accounts Receivable _________________

Notes Receivable _________________Other Current Assets _________________

Total Current Assets (1a) ________________

Non-Current Assets (over 1 year):Equipment _________________Real Estate/Land _________________Other Non-Current Assets _________________

Total Non-Current Assets (1b) ________________

TOTAL ASSETS (1a+1b) (1c) ________________

LIABILITIES Current Liabilities (1 year or less)

Notes Payable ________________Leases Payable ________________Accounts Payable ________________Other Current Liabilities ________________

Total Current Liabilities (2a) ________________

Non-Current Liabilities (over 1 year): Notes Payable – Long term ________________ Notes Payable – Equipment ________________Other Non-Current Liabilities ________________

Total Non-Current Liabilities (2b) ________________

TOTAL LIABILITIES (2a+2b) (2c) ________________

Equity/Capital Stock (1c-2c) (2d) ________________

TOTAL LIABILITIES & EQUITY (2c+2d, must equal 1c)

Printed Name of Owner/Agent __________________________________________________________Date___________________

Signature of Owner/Agent __________________________________________________________Date___________________

Name and detailed business address of the person and/or the firm that prepared this annual balance sheet.

____________________________________________________________________________________________________________

____________________________________________________________________________________________________________(Phone Number) (Fax Number) (Email Address)

$0.00

$0.00

$0.00

$0.00

$0.00

$0.00

$0.00



10

Form C-32 7-10-06



ANNUAL GROSS RECEIPTS SURVEY

THE FIRM IDENTIFIED BELOW ACKNOWLEDGES AND CERTIFIES THAT THIS PAGE ACCURATELY

REPRESENTS THE INFORMATION CONTAINED HEREIN.

AUTHORIZED

REPRESENTATIVE_____________________________________SIGNATURE______________________________________

TITLE_________________________________________________________________________________________________

FIRM’S FULL LEGAL NAME________________________________________VENDOR NO._________________

FIRM’S ADDRESS_____________________________________________________________________________________________

CITY______________________________________STATE________________________ZIP CODE_____________________

AGE OF FIRM___________________________________ FIRM’S STATUS: DBE__________ NON-DBE_________

ANNUAL GROSS RECEIPTS FOR THE FIRM’S FISCAL YEAR ENDING________________________________

PLEASE CHECK THE APPROPRIATE BRACKET

0 - $10,000 $35 Mill ion - $40 Mill ion

$10,000 - $25,000 $40 Mill ion - $45 Mill ion

$25,000 - $50,000 $45 Mill ion - $50 Mill ion

$50,000 - $100,000 $50 Mill ion - $55 Mill ion

$100,000 - $250,000 $55 Mill ion - $60 Mill ion

$250,000 - $500,000 $60 Mill ion - $65 Mill ion

$500,000 - $1 Million $65 Million - $70 Million

$1 Million - $2 Million $70 Million - $75 Million






$25 Million - $30 Million Over $100 Million

$30 Million - $35 Million

COMMENTS: ____________________________________________________________________________

_______________________________________________________________________________



11

Form C 32

7-10-06

AFFIDAVITThis form must be signed by an authorized company officer and notarized.

A MATERIAL OR FALSE STATEMENT OR OMISSION MADE IN CONNECTION WITH THIS APPLICATION

IS SUFFICIENT CAUSE FOR DENIAL OF PREQUALIFICATION, REVOCATION OF A PRIOR APPROVAL,INITIATION OF SUSPENSION OR DEBARMENT PROCEEDINGS, AND MAY SUBJECT THE PERSONAND/OR ENTITY MAKING THE FALSE STATEMENT TO ANY AND ALL CIVIL AND CRIMINALPENALTIES AVAILABLE PURSUANT TO APPLICABLE FEDERAL AND STATE LAW.

STATE OF CITY/COUNTY OF

I, (full name printed), swear or affirm under penalty of

law that I am (title) of applicant firm

(firm name) and that I have read and understand all of the questions in thisapplication and that all of the foregoing information and statements submitted in this application and itsattachments and supporting documents are true and correct to the best of my knowledge, and that all responsesto the questions are full and complete, omitting no material information. The responses include all materialinformation necessary to fully and accurately identify and explain the operations, capabilities and pertinent

history of the named firm as well as the ownership, control, and affiliations thereof.

I recognize that the information submitted in this application is for the purpose of inducing prequalificationapproval by VDOT. I understand that VDOT may, by means it deems appropriate, determine the accuracy andtruth of the statements in the application, and I authorize such agency to contact any entity named in theapplication, and the named firm’s bonding companies, banking institutions, credit agencies, contractors, clients,and other certifying agencies for the purpose of verifying the information supplied and determining the namedfirm’s eligibility.

I agree to submit to government audit, examination and review of books, records, documents and files, inwhatever form they exist, of the named firm and its affiliates, inspection of its place(s) of business andequipment, and to permit interviews of its principals, agents, and employees. I understand that refusal to permitsuch inquiries shall be grounds for denial or the loss of our firm’s prequalification privileges.

I agree to provide written notice to the Virginia Department of Transportation of any material change in theinformation contained in the original application within 30 calendar days of such change (e.g., ownership,address, telephone number, etc.).

I acknowledge and agree that any misrepresentations in this application or in records pertaining to a contract orsubcontract will be grounds for terminating any contract or subcontract which may be awarded; denial orrevocation of prequalification; suspension and debarment; and for initiating action under federal and/or statelaw concerning false statement, fraud or other applicable offenses.

I declare under penalty of perjury that the information provided in this application and supporting documents istrue and correct.

Printed Name of Authorized Company Officer Signature

Sworn to before me this ____________ day of ________________, 200____.

(Seal) Notary PublicMy Commission expires .

Mail completed application to: Virginia Department of TransportationPrequalification Officer1401 East Broad StreetRichmond, Virginia 23219



12

APPENDIX A

SAMPLE CERTIFICATION OF EXPERIENCE

MODIFICATION RATIO

(MUST BE PRINTED ON THE AGENCY LETTERHEAD)

Date:__________________

Virginia Department of TransportationScheduling and Contract Division1401 East Broad StreetRichmond, Virginia 23219

ATTN: Prequalification Office

RE:(Contractor’s Name)

(Address)

(City/State/Zip)

Dear Sir:

This is to certify that our company insures the above referenced contractor and theirExperience Modification Rate (EMR) for the past three years is as follows:

YEAR EMR

______ ______

______ ______

______ ______

Sincerely,

Agency Name:

By:Authorized Agency Representative & Title



13

APPENDIX B

Quality Score Sheet (1 of 2)

Quality Score X .70 Quality Score X .70 Quality Score X .70 Quality Score X .70

100.0 70.00 95.9 67.13 91.8 64.26 87.7 61.39

99.9 69.93 95.8 67.06 91.7 64.19 87.6 61.32

99.8 69.86 95.7 66.99 91.6 64.12 87.5 61.25

99.7 69.79 95.6 66.92 91.5 64.05 87.4 61.18

99.6 69.72 95.5 66.85 91.4 63.98 87.3 61.11

99.5 69.65 95.4 66.78 91.3 63.91 87.2 61.04

99.4 69.58 95.3 66.71 91.2 63.84 87.1 60.97

99.3 69.51 95.2 66.64 91.1 63.77 87.0 60.90

99.2 69.44 95.1 66.57 91.0 63.70 86.9 60.83

99.1 69.37 95.0 66.50 90.9 63.63 86.8 60.76

99.0 69.30 94.9 66.43 90.8 63.56 86.7 60.69

98.9 69.23 94.8 66.36 90.7 63.49 86.6 60.6298.8 69.16 94.7 66.29 90.6 63.42 86.5 60.55

98.7 69.09 94.6 66.22 90.5 63.35 86.4 60.48

98.6 69.02 94.5 66.15 90.4 63.28 86.3 60.41

98.5 68.95 94.4 66.08 90.3 63.21 86.2 60.34

98.4 68.88 94.3 66.01 90.2 63.14 86.1 60.27

98.3 68.81 94.2 65.94 90.1 63.07 86.0 60.20

98.2 68.74 94.1 65.87 90.0 63.00 85.9 60.13

98.1 68.67 94.0 65.80 89.9 62.93 85.8 60.06

98.0 68.60 93.9 65.73 89.8 62.86 85.7 59.99

97.9 68.53 93.8 65.66 89.7 62.79 85.6 59.92

97.8 68.46 93.7 65.59 89.6 62.72 85.5 59.85

97.7 68.39 93.6 65.52 89.5 62.65 85.4 59.78

97.6 68.32 93.5 65.45 89.4 62.58 85.3 59.71

97.5 68.25 93.4 65.38 89.3 62.51 85.2 59.64

97.3 68.11 93.2 65.24 89.1 62.37 85.0 59.50

97.2 68.04 93.1 65.17 89.0 62.30 84.9 59.43

97.1 67.97 93.0 65.10 88.9 62.23 84.8 59.36

97.0 67.90 92.9 65.03 88.8 62.16 84.7 59.29

96.9 67.83 92.8 64.96 88.7 62.09 84.6 59.22

96.8 67.76 92.7 64.89 88.6 62.02 84.5 59.15

96.7 67.69 92.6 64.82 88.5 61.95 84.4 59.08

96.6 67.62 92.5 64.75 88.4 61.88 84.3 59.01

96.5 67.55 92.4 64.68 88.3 61.81 84.2 58.94

96.4 67.48 92.3 64.61 88.2 61.74 84.1 58.87

96.3 67.41 92.2 64.54 88.1 61.67 84.0 58.80

96.2 67.34 92.1 64.47 88.0 61.60 83.9 58.73

96.1 67.27 92.0 64.40 87.9 61.53 83.8 58.66

96.0 67.20 91.9 64.33 87.8 61.46 83.7 58.59



14

APPENDIX B

Quality Score Sheet (2 of 2)

Quality Score X .70 Quality Score X .70 Quality Score X .70 Quality Score X .70

83.6 58.52 81.4 56.98 79.2 55.44 77.0 53.90

83.5 58.45 81.3 56.91 79.1 55.37 76.9 53.83

83.4 58.38 81.2 56.84 79.0 55.30 76.8 53.76

83.3 58.31 81.1 56.77 78.9 55.23 76.7 53.69

83.2 58.24 81.0 56.70 78.8 55.16 76.6 53.62

83.1 58.17 80.9 56.63 78.7 55.09 76.5 53.55

83.0 58.10 80.8 56.56 78.6 55.02 76.4 53.48

82.9 58.03 80.7 56.49 78.5 54.95 76.3 53.41

82.8 57.96 80.6 56.42 78.4 54.88 76.2 53.34

82.7 57.89 80.5 56.35 78.3 54.81 76.1 53.27

82.6 57.82 80.4 56.28 78.2 54.74 76.0 53.20

82.5 57.75 80.3 56.21 78.1 54.67 75.9 53.13

82.4 57.68 80.2 56.14 78.0 54.60 75.8 53.06

82.3 57.61 80.1 56.07 77.9 54.53 75.7 52.99

82.2 57.54 80.0 56.00 77.8 54.46 75.6 52.92

82.1 57.47 79.9 55.93 77.7 54.39 75.5 52.85

82.0 57.40 79.8 55.86 77.6 54.32 75.4 52.78

81.9 57.33 79.7 55.79 77.5 54.25 75.3 52.71

81.8 57.26 79.6 55.72 77.4 54.18 75.2 52.64

81.7 57.19 79.5 55.65 77.3 54.11 75.1 52.57

81.6 57.12 79.4 55.58 77.2 54.04 75.0 52.50

81.5 57.05 79.3 55.51 77.1 53.97



15

APPENDIX C

Safety Score Sheet

EMR Safety Score X.30 EMR Safety Score X.30

0.00-0.50 100.00 30.00 0.91 79.50 23.85

0.51 99.50 29.85 0.92 79.00 23.70

0.52 99.00 29.70 0.93 78.50 23.55

0.53 98.50 29.55 0.94 78.00 23.40

0.54 98.00 29.40 0.95 77.50 23.25

0.55 97.50 29.25 0.96 77.00 23.10

0.56 97.00 29.10 0.97 76.50 22.95

0.57 96.50 28.95 0.98 76.00 22.80

0.58 96.00 28.80 0.99 75.50 22.65

0.59 95.50 28.65 1.00 75.00 22.50

0.60 95.00 28.50 1.01 74.50 22.35

0.61 94.50 28.35 1.02 74.00 22.20

0.62 94.00 28.20 1.03 73.50 22.05

0.63 93.50 28.05 1.04 73.00 21.90

0.64 93.00 27.90 1.05 72.50 21.75

0.65 92.50 27.75 1.06 72.00 21.60

0.66 92.00 27.60 1.07 71.50 21.45

0.67 91.50 27.45 1.08 71.00 21.30

0.68 91.00 27.30 1.09 70.50 21.15

0.69 90.50 27.15 1.10 70.00 21.00

0.70 90.00 27.00 1.11 69.50 20.85

0.71 89.50 26.85 1.12 69.00 20.70

0.72 89.00 26.70 1.13 68.50 20.55

0.73 88.50 26.55 1.14 68.00 20.40

0.74 88.00 26.40 1.15 67.50 20.25

0.75 87.50 26.25 1.16 67.00 20.10

0.76 87.00 26.10 1.17 66.50 19.95

0.77 86.50 25.95 1.18 66.00 19.80

0.78 86.00 25.80 1.19 65.50 19.65

0.79 85.50 25.65 1.20 65.00 19.50

0.80 85.00 25.50 1.21 64.50 19.35

0.81 84.50 25.35 1.22 64.00 19.20

0.82 84.00 25.20 1.23 63.50 19.05

0.83 83.50 25.05 1.24 63.00 18.900.84 83.00 24.90 1.25 62.50 18.75

0.85 82.50 24.75 1.26 62.00 18.60

0.86 82.00 24.60 1.27 61.50 18.45

0.87 81.50 24.45 1.28 61.00 18.30

0.88 81.00 24.30 1.29 60.50 18.15

0.89 80.50 24.15 1.30 60.00 18.00

0.90 80.00 24.00



25

Form C-32ARev 1-30-07

VIRGINIA DEPARTMENT OF TRANSPORTATION

PREQUALIFICATION RENEWAL APPLICATION

This application may be completed by currently prequalified firms preparing to begin their second year of the two-year prequalification cycle.

_____________________________________________________________________________ (Firms full legal name)

________________________________________________________________________________________________*(Firms mailing address)

_____________________________________________________________________________

(City) (State) (Zip)

__________________ ________________ _________________________________(Telephone Number) (Fax Number) (Email Address)

____ * Please check here if this is a change of the firm’s mailing address.

ALL RENEWAL APPLICANTS MUST COMPLETE

Have there been any significant changes in the following critical operational areas since the submission of your firm’s

last C32 application? (If yes, please provide appropriate documentation on selected pages of a Form C-32 and/orexplain the changes on a separate sheet of paper).

Document and attach the foll owing YES NO

1. Any Changes in Organizational Structure (Corporation, LimitedPartnership, L imited Liability Company, Sole Proprietorship, GeneralPartnership, Bus iness Trust)?

2. Any change in Ownership Interest of 10% or more?

3. Any change in Authorized Individuals?

4. Any change in Firm to Firm relationships?

5. Any changes in the nature of the firm’s work expertise?

6. Any gain, loss, or access to equipment that may negatively orpositively impact the firm’s ability to perform highway construction?

7. Has the firm been debarred, denied prequalification, or denied biddingprivileges with another agency or any other DOT? If yes, attach a copyof the debarred/denial letter.

8. Attach a complete original annual financial statement

9. Attach the Status of current Prime Contracts on Hand (Form C42)

10. Attach the Status of current Subcontracts on hand (Form C-42A)

11. Attach an original Certification of Experience Modification Rate

12. Attach an Annual Gross Receipts Survey (Page 10 of Form C32)



26

Form C 32ARev 1-30-07

AFFIDAVIT

This form must be signed by an authorized company officer and notarized.

A MATERIAL OR FALSE STATEMENT OR OMISSION MADE IN CONNECTION WITH THIS APPLICATIONIS SUFFICIENT CAUSE FOR DENIAL OF PREQUALIFICATION, REVOCATION OF A PRIOR APPROVAL,

INITIATION OF SUSPENSION OR DEBARMENT PROCEEDINGS, AND MAY SUBJECT THE PERSONAND/OR ENTITY MAKING THE FALSE STATEMENT TO ANY AND ALL CIVIL AND CRIMINALPENALTIES AVAILABLE PURSUANT TO APPLICABLE FEDERAL AND STATE LAW.

STATE OF _____ CITY/COUNTY OF

I, __(full name printed), swear or affirm under penalty of

law that I am (title) of applicant firm __________________

(firm name) and that I have read and understand all of the questions in this application and that all of

the foregoing information and statements submitted in this application and its attachments and supporting documents are true and

correct to the best of my knowledge, and that all responses to the questions are full and complete, omitting no material information.

The responses include all material information necessary to fully and accurately identify and explain the operations, capabilities and pertinent history of the named firm as well as the ownership, control, and affiliations thereof.

I recognize that the information submitted in this application is for the purpose of inducing prequalification approval by VDOT. I

understand that VDOT may, by means it deems appropriate, determine the accuracy and truth of the statements in the application, and

I authorize such agency to contact any entity named in the application, and the named firm’s bonding companies, banking institutions,credit agencies, contractors, clients, and other certifying agencies for the purpose of verifying the information supplied and

determining the named firm’s eligibility.

I agree to submit to government audit, examination and review of books, records, documents and files, in whatever form they exist, ofthe named firm and its affiliates, inspection of its place(s) of business and equipment, and to permit interviews of its principals, agents,

and employees. I understand that refusal to permit such inquiries shall be grounds for denial or the loss of our firm’s prequalification

privileges.

I agree to provide written notice to the Virginia Department of Transportation of any material change in the information contained in

the original application within 30 calendar days of such change (e.g., ownership, address, telephone number, etc.).

I acknowledge and agree that any misrepresentations in this application or in records pertaining to a contract or subcontract will be

grounds for terminating any contract or subcontract which may be awarded; denial or revocation of prequalification; suspension anddebarment; and for initiating action under federal and/or state law concerning false statement, fraud or other applicable offenses.

I declare under penalty of perjury that the information provided in this applicat ion and supporting documents is true and correct.

Printed Name of Authorized Company Officer Signature

Sworn to before me this ____________ day of _____________________________, 200_______.

(Seal)

Notary Public

My Commission expires _________ .

Mail completed application to: Virginia Department of TransportationPrequalification Officer

1401 East Broad Street

Richmond, Virginia 23219



STATUS OF CURRENT PRIME CONTRACTS ON HAND

Give full information about all of your contracts as a PRIME contractor whether in progress or awarded but not yet begun; or where you arecontract. This information cannot be older than 60 days.

-1-OWNER

-2-CONTRACTS

LOCATION & DESCRIPTION

-CONT

AMO

Page _____ of _____ Total Chargeable Balance to be completed (Total of C

GRAND TOTAL OF ALLIn case of joint venture show only your share.

_____ A I certify the above contract amounts are the true representation of all of the work this firm is responsible for as a PRIME contractor as of the date

_____ B I certify that this firm has no work underway as a PRIME contract and is responsible for no work as of the date stated below.

________________________________________________________________________Company’s Full Legal Name Signature of an Authorized Company Official



STATUS OF CURRENT SUBCONTRACTS ON HANDGive full information about all of your subcontracts as a SUB CONTRACTOR whether in progress and all signed subcontract agreements w

This information cannot be older than 60 days.

-1-OWNER

-2-PRIME CONTRACTOR

-3-CONTRACT’S

LOCATION & DESCRIPTIONSUBC

A

Page _____ of _____ Total Chargeable Balance to be completed (Total of Colum

GRAND TOTAL OF ALL PA

_____ A I certify the above contract amounts are the true representation of all of the work this firm is responsible for as a SUB contractor as of the date sta

_____ B I certify that this firm has no work underway as a SUBCONTRACTOR and is responsible for no work as of the date stated below.

________________________________________________________________________Company’s Full Legal Name Signature of an Authorized Company Official



Form C-47

6/12/06

Request for Protection of Prequalification Materials

From Disclosure Under the

Virginia Freedom of Information Act

Please read before completing this form:The Virginia Public Procurement Act allows for the exemption of certain Prequalification information from public disclosure. Acontractor must request the exemption in writing in order that information contained in the Prequalification application and financial

statement be withheld from public view, under the Virginia Freedom of Information Act. This can be accomplished by completing this

form. This form must indicate the legal name of the company, the items to be protected, and the reason why the exemption is being

requested. (Please be specific) and state specifically why each item is exempt. The Virginia Court System has held that the contents ofthe entire file may not be protected. For example, just indicating” entire file” is to be exempt is not specific enough and will not

protect your information from being disclosed. This request must be signed by an authorized officer of the company as authorized on

page 2 of the Prequalification Application (Form C-32).

In submission of it’s Prequalification materials:

________________________________________________________________________(Firms Full Legal Name) ________________________________________________________________________

hereby invokes the protection of Section 2.2-4342 of the Code of Virginia (Virginia

Public Procurement Act), and request protection from public disclosure of certain

ownership information.

The data or materials to be protected are:

________________________________________________________________________

________________________________________________________________________ ________________________________________________________________________

________________________________________________________________________

The reasons why such protection is necessary are:

________________________________________________________________________

________________________________________________________________________ ________________________________________________________________________

____ No protection of our prequalification submission is being requested. (Please check

if applicable).

______________________________________ ______________________________(SIGNATURE OF AN AUTHORIZED COMPANY OFFICER) (DATE)





DEBARMENT AND/OR SUSPENSION POLICY

I. Purpose

Section 33.1-187 of the Code of Virginia ensures that all contracts for the construction, improvement

and maintenance of roads be awarded to the lowest responsible bidder. These contract awards will be the resul

of open competitive bidding, impartial selection of contracts, honest business practices, and skillful execution of

public contracts. The Commonwealth Transportation Board, as the governing body of public agency, has wide

discretion in determining the responsibility of the contractor, particularly regarding their moral and ethical judgment. The Board will consider debarring a contractor under the circumstances and by the procedures

outlined in this document.

II. Definitions

Affiliate - Any business entity that controls or can be controlled by another corporation. An affiliate

could also be any entity which has been so closely allied with another by lending financial assistance or

participating in joint ventures that the relationship has created the public perception that the two firms are

a single entity.

Bidding Crime - Any act in violation of state or federal law including, but not limited to, fraud

conspiracy, collusion, perjury or material misrepresentation.

Board - The Commonwealth Transportation Board. A sixteen member body appointed by the Governor

of Virginia to make decisions on transportation related issues.

Contractor - Any prequalified person, partnership, corporation or other business entity seeking to bid on

any contract let by the Department. A contractor could also function or seek to function as a

subcontractor, materials supplier, or equipment supplier for any contract used in the construction or

maintenance of the transportation system. This firm must be legally authorized, as stated in Section 13.1

of the Code of Virginia, to conduct business in the Commonwealth.

Debar - To disqualify from contracting with the Department due to perceived irresponsibility of the

contractor.

Department - The Virginia Department of Transportation.

- 1 -



Enjoin - To impose bidding restrictions on a contractor.

MBE - Minority Business Enterprise. A small business entity, as defined pursuant to Section 3 of the

Small Business Act and related regulations, that is owned and controlled by one or more minorities. This

term shall also include Disadvantaged Business Enterprises (DBEs) and Women Business Enterprises

(WBEs).

Reinstate - To modify or suspend debarment.

Subcontractor - An individual, partnership, corporation, or other business entity to which the prime

contractor sublets or proposes to sublet any portion of a contract.

III. Enjoinment

The Department may enjoin a contractor from bidding in accordance with Section 102.01 of the Road

and Bridge Specifications. The enjoinment of a contractor will result in the enjoinment of any affiliate that has

essentially the same operational management or draws from the same labor resource pool. Enjoined contractors

and their affiliates will be disqualified from performing work as subcontractors if the Construction Engineer

determines that such work could adversely affect other work under contract to the Department. Enjoinment of a

contractor by the Department is based on the contracting power of the Department and the discretionary power

of the Department. Enjoinment will be issued when, in the opinion of the Department, the contractor has failed

to fulfill its obligations under a past contract or in the performance of a current contract.

A. Section 110.04 establishes the guidelines for the use of MBE firms for subcontracting. If the

contractor fails to submit the required information as described in this section within the specified

time frame, he and his affiliates may be enjoined until the submissions are received by the

Department.

Enjoinment may be imposed for up to 60 days if a contractor fails to meet his MBE participation

goals for each quarter of the contract as shown on the progress schedule. Upon conformance

with the schedule, enjoinment may be lifted.

Enjoinment may be avoided if either of the following occurs:

• the MBE is unable or unwilling to complete his portion of the work, and the prime

contractor shows reasonable effort to fulfill the MBE requirement otherwise.

• the Department has eliminated or delayed work which the contractor, as shown on the

progress schedule, had planned to sublet to an MBE firm.

If the contractor fails to meet the MBE participation requirements upon completion of the project

the contractor and any affiliates may be enjoined for 90 days. Prior to enjoinment, the contractor

may submit documentation to the Construction Engineer indicating the reasons for failure to

comply with the requirements. If the failure to comply was due solely to quantity under-runs or

elimination of items subcontracted to MBEs, the contractor must show that all feasible means

were used to obtain the required participation. The Construction Engineer will determine if the

contractor has met the contract requirements.

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If the Construction Engineer determines that the contract requirements were not met, the

contractor may request an appearance before a panel appointed by the Commissioner. The

contractor must explain to the panel how all feasible means were used to meet the MBE

participation requirements. Enjoinment will begin upon the contractor’s failure to request a

hearing or upon the panel’s final decision.

The Department will not enjoin a firm that has complied with the contract requirements on all

issues but failed to meet the MBE goals of the project, when the contractor has achieved a levelthat is at least equal to the current federal requirements placed on the Commonwealth.

B. Section 102.01 requires all contracted work to be completed as scheduled. If a contractor is

delinquent in excess of ten (10) percent either on the basis of time or money, enjoinment may be imposed

A contractor’s delinquency will be determined by comparing the monthly progress estimate to the latest

approved project schedule. If the contractor does not complete the necessary work to eliminate the

discrepancy within thirty (30) calendar days, or he does not establish that the delinquency was attributable

to conditions beyond his control, he may be removed from the list of prequalified bidders until final

acceptance of the project.

IV. Debarment

The Commissioner, in his sole discretion, may debar a contractor or his affiliates for any of the following

reasons:

A. Proof of involvement in a bidding crime, including

1. conviction,

2. a plea of guilty or nolo contendere,

3. a public admission by a co-conspirator, or

4. contractor testimony protected by a grant of immunity in any jurisdiction;

B. Conviction of an offense that shows a lack of moral or ethical integrity by the company;

C. Debarment by some other state or federal agency for any reason.

According to Board policy, the contractor will be given an opportunity for an informal hearing before the

Commissioner. At the sole discretion of the Commissioner, the hearing could be held before or after debarmen

is imposed. If the Commissioner determines that the hearing may be held prior to debarment, he shall sendwritten notice by mail to the affected contractor or his agent stating the following:

• debarment is being considered;

• general reasons for the debarment;

• the contractor will be granted a hearing, if it is requested within ten (10) working days of having

received the Commissioner’s notice.



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Unless mutually agreed upon otherwise, the hearing will be held no later than ten (10) working days after

the Department has received the contractor’s request. The Commissioner’s decision concerning debarment wil

be reviewed by the Board and executed within thirty (30) calendar days following the next regularly scheduled

Board meeting.

If the Commissioner determines that debarment is appropriate prior to the hearing, he shall send a writtennotice by registered mail stating the following:

• the affected contractor has been debarred;

• general reasons for the debarment;

• the contractor will be granted a hearing, if it is requested within ten (10) working days of having

received notice of debarment.

If the contractor notifies the Commissioner that he desires a hearing, it will be held within ten (10)working days of the contractor’s request, unless mutually postponed. The Commissioner’s decision whether to

reinstate the contractor will be reviewed by the Board and executed no later than thirty (30) calendar days

following the next regularly scheduled Board meeting.

V. Rules Applicable to Debarment

A. The illegal or improper conduct of an individual may be fully imputed to the firm with which they are

or were, employed when the conduct in question occurred. Furthermore, the illegal or improper conduc

of a firm may be fully imputed to an individual or individuals having control over the affairs of the firm.

B. Debarment of a contractor in no way affects his obligations to the Commonwealth for any servicesalready under contract.

C. The debarment may be imposed for any length of time.

D. If the Board finds that debarment proceedings would not be in the public’s best interest because they

may hinder federal/state investigations into a bidding crime, the proceedings may be delayed until those

investigations are concluded. Any delay of the proceedings shall be made after written notice and an

opportunity for a hearing are given to the contractor.

E. Any contractor currently prequalified to bid on Department contracts shall notify the Commissioner

within thirty (30) calendar days of being convicted of any bidding crime. The same applies to anycontractor who has previously bid or performed business as a material or equipment supplier. Failure to

do so is a serious and compelling offense which alone could result in debarment.

F. Debarment of a contractor applies to any successor company formed with the same resources, owners

or stockholders as the debarred entity.

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VI. Reinstatement

The Board may suspend debarment at any time if the suspension is in the public’s best interest.

Mitigating circumstances may be considered in the decision to reinstate a contractor. These circumstances may

include the following:

A. The degree of culpability of the contractor;

B. Whether a lengthy debarment will protect the Commonwealth;

C. Restitution by the debarred contractor to the Commonwealth for any perceived overcharges or other

damages resulting from a bidding crime. The Board believes restitution may indicate an acknowledgment

by the contractor of the wrongfulness of his acts and may indicate a sincere desire to improve future

conduct;

D. Cooperation by the debarred contractor with the Commonwealth, the United States and/or other

sovereign bodies in the investigation of bidding crimes, including a full and complete account of the

contractor’s involvement;

E. Disassociation with the individuals and firms that have been involved in a bidding crime.

The Board may request that the Commissioner hold a hearing to consider reinstatement. This hearing

will take place no later than fifteen (15) working days prior to the last day of the debarment. After receiving the

Commissioner’s report, the Board may determine that the contractor has not acted as a responsible bidder and

decide to continue the debarment period indefinitely. At any time during the debarment period the contractor

may justify why the penalty should be lifted. The debarment may be lifted once the Board has determined tha

the contractor qualifies as a responsible bidder.

VII. Supplier

The Debarment and/or Suspension Policy shall be fully applicable to all contractors eligible to do business

with the Department’s Administrative Services Division. When possible, these contractors will receive a notice

regarding the applicability of this policy to their situation.

The Department is empowered to set those terms, conditions or specifications in its contracts that are

necessary to preclude a contractor’s participation as a supplier when he is not prequalified.

VIII. Notice to Contractor

A copy of these guidelines shall be distributed to each prequalified contractor.

Amended: September 15, 1983

July 1, 1985

September 5, 1991

June 16, 1993

prequal app new

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